Pioneer in palliative care
It was a lucky day for the University of Western Australia (UWA), and for palliative care in Western Australia, when the Rev Dr Douglas MacAdam answered an advertisement in the British Medical Journal seeking a senior lecturer to work in the university’s new Department of General Practice.
Experienced in mental health, alcohol rehabilitation and palliative care, Douglas was also the principal of a large National Health Service (NHS) general practice in Leeds and a senior lecturer in general practice at the University of Leeds. He had co-authored a book on clinical thinking and practice,1 and had written three oft-cited papers on the causes of delayed diagnosis and treatment of intestinal cancers.2–4
Douglas, his wife Ruth and two sons Hugh and Bruce arrived for the start of the 1980 WA academic year. His daughter Clare was finishing her studies in the UK and came later.
The Royal Australian College of General Practitioners
The Royal Australian College of General Practitioners (RACGP) granted Douglas a Fellowship ad eundem gradum in 1981. He was to prove an asset to the college, making his mark as an examiner, researcher, training advisor and member of the RACGP WA Board.
Claremont General Practice
Douglas was a smart clinician. He and I shared the clinical duties of a full-time equivalent general practitioner (GP), an arrangement that resulted in us sharing the care of many of our patients. This was to the patients’ advantage, since there were occasions when the strengths of one of us complemented the other’s weaknesses.
Douglas was both respected and popular with patients, as well as with the nursing and reception staff.
University of Western Australia
During his time at UWA, Douglas was appointed Chair of the UWA Human Rights Committee, and was Head of the Department of General Practice from 1987–89 within the Faculty of Medicine.
Background and professional interests
Douglas came from a medical family. His father, Sir William MacAdam, was Professor of Medicine at the University of Leeds and his mother, Irene Trinker, was also a doctor, as were his brother Arthur and sister Brenda.5
Douglas trained at St Bartholomew’s Hospital in London and was a medical graduate of the University of Cambridge.
A year after graduation from his medical degree, Douglas obtained a Bachelor of Divinity from the University of London and was ordained in the same week that he married his long-time girlfriend, Ruth Bell.
Douglas was an early participant in the new movement to provide better care for the dying. He attended courses run by Dr Cicely Saunders, the founder of St Christopher’s in London, the world’s first purpose-built hospice, and in 1975 he became founding Chair of the pioneering Wheatfield’s Hospice in Leeds.
Palliative care in WA
It was in WA that Douglas made his major contribution to compassionate medical and pastoral care of the terminally ill in Australia.
His idea was to set up a domiciliary service for the terminally ill involving the Silver Chain Domiciliary
Nursing Service, interested GPs and supported by appropriately trained volunteers. Douglas worked closely with Clive Deverall, Director of the Cancer Council of Western Australia (a forerunner to Cancer Council WA), Joy Brann, a senior lecturer in nursing at the WA Institute of Technology (now Curtin University), and later with Dr Rosalie Shaw, who had independently set up the first terminal care unit in WA at the Hollywood Repatriation General Hospital and later became a senior lecturer in palliative care in UWA’s Department of General Practice. Together, the three of them ran courses for medical students, nurses and doctors.6–9
It was also the intention of these palliative care pathfinders to establish a hospice care facility, a process that took them longer than establishing the domiciliary service for the terminally ill. It required the help of the Cancer Foundation of WA, a public appeal for funds that raised $1 million and a grant of land from the WA State Government. Cottage Hospice was built in Shenton Park, opening in 1987. Douglas was Chair of its Board of Management and was appointed Medical Director in 1990.
Honours
Douglas was WA Citizen of the Year in 1992 and awarded a Centenary Medal in 2001. Both of these prestigious honours were bestowed for his services to the WA community.
In retirement, Douglas enjoyed caravanning across Australia with Ruth, carpentry, playing golf and listening to classical music. Ruth died in 2005. While he was able, Douglas, who lived next door to his son Bruce, spent much time with his grandchildren.
Douglas died on 17 October 2018, the eve of St Luke’s Day.
A commemoration of Douglas’ life was held at the Nedlands Uniting Church, where he had been an associate minister. He is survived by his daughter Clare Arrowsmith, sons Hugh and Bruce, younger brother Arthur and eight grandchildren.
Dr Douglas MacAdam was a wonderful academic colleague and the sort of GP that every patient wants. He will be sadly missed.
Dr Max Kamien
- Wright HJ, MacAdam DB. Clinical thinking and practice: Diagnosis and decision in patient care. Edinburgh: Churchill Livingstone, 1979.
- Irvin TT, MacAdam DB. Delay in diagnosis of symptomatic colorectal cancer. Lancet 979;313(8114):489–90.
- MacAdam DB. A study in general practice of the symptoms and delay patterns in the diagnosis of gastrointestinal cancer. J R Coll Gen Pract 1979;29(209):723–29.
- MacAdam DB. Early diagnosis of gastric and oesophageal cancer. Practitioner 1983;227(1378):537–40.
- Wolstenholme G, editor. Munk’s Roll, vol VII: Lives of the Fellows of the Royal College of Physicians of London, 1976–1983. Oxford: IRL Press, 1984; p. 348.
- MacAdam DB. Care of the dying. Relevance of the hospice concept to general practice. Aust Fam Physician 1983;12(4):249–50.
- MacAdam DB. Drug management of common symptoms in the dying patient. Aust Fam Physician 1983;12(4):230–32.
- MacAdam DB. Teaching palliative medicine. Med J Aust 1992;156(3):192–93,196.
- MacAdam DB. Palliative medicine: Future directions. Aust Fam Physician 1988;17(11):991–92,995.